Nocturnal blood pressure decrease in patients with chronic kidney disease and in healthy controls – significance of obstructive sleep apnea and renal function

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Background: Chronic kidney disease (CKD) is often associated with a blunted nocturnal BP decrease and OSA. However, it is not fully clear whether a relationship exists between reduction in renal function and obstructive sleep apnea (OSA) on the one hand and relative nocturnal BP decrease in CKD patients on the other. The aim of this study was to investigate the association between nocturnal BP decrease and renal function, the degree of OSA, vasoactive hormones, and renal sodium handling in CKD3-4 patients and healthy age-matched controls. Methods: We performed brachial and central 24-hour ambulatory BP measurement and CRM in 70 CKD3-4 patients and 56 controls. In plasma, we measured renin, AngII , aldosterone, and vasopressin. In urine, 24-hour excretion of sodium, protein fractions from the epithelial sodium channel (u-ENaCγ), and the AQP2 water channels (u-AQP2) were measured. Results: CKD patients had lower relative nocturnal BP decrease than controls: brachial (10% vs 17%, P =0.001) and central (6% vs 10%, P =0.001). Moderate-to-severe OSA was more frequent in patients (15 vs 1%, P <0.0001). Neither the presence of OSA nor eGFR were predictors of either brachial or central nocturnal BP decrease. CKD3-4 nondippers were more obese, had higher HbA1c level, and more often a history of acute myocardial infarction than CKD3-4 dippers ( P <0.05). Conclusion: CKD3-4 patients had lower brachial and central nocturnal BP decrease than healthy controls. OSA and eGFR were not associated with nondipping in CKD patients or healthy controls. Nondipping in CKD3-4 was associated with obesity, diabetes, and cardiovascular disease. ClinicalTrials.gov ID: NCT01951196. Keywords: chronic kidney disease, nocturnal BP decrease, hypertension, OSA, central blood pressure

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